Cigarette smoking is highly prevalent among persons with posttraumatic stress disorder (PTSD) and individuals with PTSD have decreased odds of successfully quitting smoking. There is a need to develop more effective interventions and to evaluate factors associated with smoking abstinence in persons with PTSD. The use of supplemental nicotine administration during a "pre-treatment" phase before a targeted quit date is a recent innovative development in smoking cessation therapy and may be particularly helpful in treating smokers with PTSD. The use of supplemental nicotine administration during ad lib smoking for smokers with PTSD is predicted to reduce both the physiological and emotional dependence on inhaled nicotine, thereby increasing the odds of successful smoking cessation. Smokers with PTSD will be randomly assigned to 1 of 2 pre- cessation patch therapy conditions (active patch versus placebo patch) for 2 weeks before a target quit- smoking date. All participants will receive brief cognitive-behavioral therapy (CBT) and will begin standard nicotine replacement therapy (NRT) on their quit day. PTSD symptoms, mood, smoking craving and withdrawal symptoms will be carefully evaluated using electronic diary assessment. The study is designed to address the following aims: (1) To examine the effects of supplemental nicotine administration on PTSD symptoms, mood, craving, and withdrawal through electronic diary assessment, (2) To evaluate the effect of supplemental nicotine administration on quit rates among smokers with PTSD, and (3) To investigate potential predictors of relapse including individual differences in affective style including PTSD symptom severity, baseline mood, anxiety sensitivity, measures of distress tolerance, and self-efficacy. PUBLIC HEALTH RELEVANCE: This study may serve to inform development of easily portable smoking cessation strategies for smokers with PTSD by investigating: 1) the effects of supplemental nicotine administration on craving, mood, PTSD symptoms, and withdrawal;2) the possible benefit of pre-treatment with nicotine patches on abstinence rates;and 3) risk- factors for smoking relapse in this at risk population.